Basic Information
Provider Information | |||||||||
NPI: | 1902999105 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DELONG | ||||||||
FirstName: | KAREN | ||||||||
MiddleName: | SMITH | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | DELONG | ||||||||
OtherFirstName: | KAREN | ||||||||
OtherMiddleName: | LOUISE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CRNP | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 2608 KEISER BLVD | ||||||||
Address2: |   | ||||||||
City: | WYOMISSING | ||||||||
State: | PA | ||||||||
PostalCode: | 196103333 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6106855864 | ||||||||
FaxNumber: | 6109299395 | ||||||||
Practice Location | |||||||||
Address1: | 2608 KEISER BLVD | ||||||||
Address2: |   | ||||||||
City: | WYOMISSING | ||||||||
State: | PA | ||||||||
PostalCode: | 196103333 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6106855864 | ||||||||
FaxNumber: | 6109299395 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/02/2006 | ||||||||
LastUpdateDate: | 05/27/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | SP009105 | PA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.